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Risks of Mortality Associated with Nursing Assessments: A Quantitative Indication of their Reliability, Validity and Clinical Implications. Michael Rothman, PhD, Alan Solinger , PhD, Steven Rothman, MSEE , G. Duncan Finlay, MD Rothman Healthcare Corporation September 13, 2012. - PowerPoint PPT Presentation
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1© RHC 2011 – Confidential Visualizing Patient Health
Risks of Mortality Associated with Nursing Assessments:
A Quantitative Indication of their Reliability, Validity and Clinical
Implications
Michael Rothman, PhD, Alan Solinger, PhD, Steven Rothman,
MSEE, G. Duncan Finlay, MD
Rothman Healthcare Corporation
September 13, 2012
2© RHC 2012 Visualizing Patient Health
Motivation
• Florence Rothman died in a hospital, in part because of fragmentation of care; she deterioratedslowly across shifts…
• To make deterioration visible, we built an acuity model… looking at all EMR data including nursing assessments
• Nursing assessments:– 50% of a hospital’s operating budget goes to nursing, 50%
of which is computer entry… but the data is not used– From physicians, we found skepticism as to the significance
of nursing assessments
3© RHC 2012 Visualizing Patient Health
Simplified Nursing Assessments
• “Head-to-toe” assessments - part of standard nursing school curricula
• Simplified… “charting by exception”… the patient has either “met” or “not met” a minimum standard– GI standard - Abdomen soft and non-tender. Bowel sounds present.
No nausea or vomiting. Continent.
• Nursing assessments are recorded twice each day
• Every hospital records essentially the same data
4© RHC 2012 Visualizing Patient Health
Data
• 42,302 patient visits from two 1-year periods at an 805-bed community hospital
• Excluded data from patients under age 18, as well as psychiatric and maternity
5© RHC 2012 Visualizing Patient Health
Clinical Implications – 30-day mortality … Last assessment
Nursing Assessment
MetLive
MetDied
Odds Not metLive
Not metDied
Odds OddsRatio
Food 34769 705 0.02 3383 1084 0.32 16
Neurological 34600 770 0.02 3561 1018 0.29 13
Psychosocial 36327 1260 0.04 1834 525 0.29 8.3
Cardiac 31947 1119 0.04 6228 670 0.11 3.1
Pain 33618 1568 0.05 4436 218 0.05 1.1
All p-values < 0.001, except for pain, with a p-value of 0.474
6© RHC 2012 Visualizing Patient Health
Clinical Implications – 1-year mortality … Last assessment
Nursing Assessment
30-day Odds Ratio
1-yearOdds Ratio
Food 16 6.7
Neurological 13 6.5
Psychosocial 8.3 5.3
Cardiac 3.1 2.3
Pain 1.1 0.8
All p-values < 0.001, except for pain, with a p-value of 0.474
7© RHC 2012 Visualizing Patient Health
Clinical Implications – In-hospital mortality
Neurological
Respira
toryFo
od
Musculoske
letal
Psychoso
cial
Safety Sk
in
Peripheral V
ascular
Genitourin
ary
Cardiac
Gastrointesti
nalPain
02468
10 9.48.1
7 6.9 6.75.6 5.2
3.93 2.8 2.3
1.1
Odds Ratios – First assessment
8© RHC 2012 Visualizing Patient Health
Clinical Implications – Nursing Assessments
• If the first nursing assessments taken upon admission correlate with in-hospital mortality… and
• The last nursing assessments taken prior to discharge correlate with post-discharge mortality… then
• It is reasonable to infer that all nursing assessments gathered throughout the patient’s stay contain significant clinical information
9© RHC 2012 Visualizing Patient Health
Conclusion – Simplified Nursing Assessments• A “new” longitudinal source of clinical information
• Important as input data for an acuity model (Rothman Index)
• Creates the potential to help nurses and physicians see deterioration and improve the continuity of care
For more information … [email protected]
Reference – Rothman, MJ, Solinger, AB, Rothman, SI and Finlay GD, Clinical Implications and Validity of Nursing Assessments: A Longitudinal Measure of Patient Condition from Analysis of the Electronic Medical Record. BMJ Open 2(4) 2012.